North Dekalb Primary Care, Llc | |
136 Commerce Ave Valley Head AL 35989 | |
(256) 674-1052 | |
(256) 674-1054 |
Full Name | North Dekalb Primary Care, Llc |
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Speciality | Family Medicine |
Location | 136 Commerce Ave, Valley Head, Alabama |
Authorized Official Name and Position | John Moore (OWNER) |
Authorized Official Contact | 2569960540 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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North Dekalb Primary Care, Llc 38109 Us Highway 11 Valley Head AL 35989-4432 Ph: (256) 996-0540 | North Dekalb Primary Care, Llc 136 Commerce Ave Valley Head AL 35989 Ph: (256) 674-1052 |
NPI Number | 1851898449 |
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Provider Enumeration Date | 04/10/2018 |
Last Update Date | 04/17/2023 |
Medicare PECOS PAC ID | 1153652011 |
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Medicare Enrollment ID | O20191008002800 |
Identifier | Type | State | Issuer |
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1851898449 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Elizabeth D Cole |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1265470900 PECOS PAC ID: 3274529201 Enrollment ID: I20130806000681 |
Provider Name | John W Moore |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518200864 PECOS PAC ID: 3971746298 Enrollment ID: I20130905000147 |
Provider Name | Deanna L Jackson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952859175 PECOS PAC ID: 9032499926 Enrollment ID: I20161212001065 |